The Future of Community Care for Schizophrenia

Posted on March 12, 2014 at 2:23 pm

A new study in India, conducted by researchers at the Centre for Global Mental Health at King’s College London, has shown that patients with schizophrenia that reside in low-income countries can benefit from community-based treatment.[1] In fact, researchers found that community care was more effective than standard facility-based care in reducing disability and psychotic symptoms, as well as helping patients stick to their medication schedules.1

“Our findings from India show even more positive outcomes than similar trials of collaborative community-based care carried out in high-income countries,” said lead researcher Graham Thornicroft, PhD.1

Under the proper supervision, using locally available human resources, community health workers, to make home visits improved the outcomes for people with schizophrenia during the trial.1

“In many low-income countries, fewer than 10 percent of people with mental health problems receive any treatment. There may be just a handful of psychiatrists, and in some countries, there are no mental health specialist doctors at all,” said Thornicroft.1

A total of 282 adults with moderate to severe schizophrenia participated in the trial.1 Of those participants, 187 were randomly chosen to receive a collaboration of community-based care and facility-based care, while the remaining 95 were to receive facility-based care (usual care) only.1 For community intervention, lay health workers were trained to deliver personal, evidence-based treatments to the patients in their home environments, under the supervision of psychiatric social workers.1 The facility-based care was offered at three sites in India.1

During a 12-month period, the primary outcome was a change in symptoms and disabilities, measured by the Positive and Negative Syndrome Scale (PANSS) and the Indian Disability Evaluation and Assessment Scale (IDEAS).1 The total PANSS and IDEAS scores were lower, or better, in the community intervention group, compared with the usual care group.1 Also, medication adherence was three times higher in the community-based intervention group.1

“By recruiting patients from real-world clinical settings across three diverse sites, our finding establish that people with schizophrenia can be treated successfully using mobile community teams in a resource-poor country,” said Thornicroft. “By moving treatment into the community, it is possible to scale up services where they are needed and scarce, as is the case in many low-income and middle-income countries.”1

Derrick Silove, MD, and Philip Ward, PhD, gave commentary on the trial: “Implementation of collaborative community-based care in low-income and middle-income countries has several issues that need further consideration, such as ensuring continuity of supervision of community workers, safeguarding the physical health of patients, and embedding services within the local context and culture.”1

However, commentators did note that the study represented a milestone in showing the benefits of this approach in a low-income setting.1